Driven To Extraction

Summer is the time for students to bite the bullet and get rid of pesky wisdom teeth

For accountants, April is crunch time. That's when the phones ring off the hook, the hours are long and the anxiety level from customers - - otherwise known as tax-filing procrastinators -- spikes. For oral surgeons, crunch time is just beginning. From now through August, local high school and college students will flock to the doctors' offices to get rid of their wisdom teeth before summer vacation is over. Rather than let the surgery cramp their style at school, they want plenty of time to recover, hide out from potential dates and milk the sympathy card with Mom and Dad.

"It gets really crazy," said Dr. Jack Mrazik, an oral and maxillofacial surgeon in Hampton. "I'd say we do two or three times more removals than usual. It makes sense, because the kids are home, available and looking at their watches as summer ticks by."

So fun in the sun turns into temporary misery under the fluorescent office lights, usually followed by gauze packs and lots of milkshakes. And as emerging research points out advantages to removing wisdom teeth early -- even if they aren't yet causing any problems -- doctors say their busy season could get even busier.

People in their teens and early 20s already make up the bulk of wisdom tooth patients. For Dr. L. Warren West, a Williamsburg surgeon who removes some 2,000 of the teeth a year, the most common age bracket is 15 to 21. Patients often come in when a dentist first spots the late-developing teeth or an orthodontist starts straightening their other teeth.

Like many oral surgeons, West generally recommends leaving wisdom teeth alone only if a patient's jaw is clearly big enough for them to come in straight and with plenty of room around them for brushing and flossing. Otherwise, he said, people have a good chance of developing problems down the road.

The operation tends to be much easier on teenagers and young adults because most don't have full-grown roots on their wisdom teeth and also have softer bone. Students usually are in and out of West's office in about an hour, and 70 percent are back to normal activity three days later -- whether that's a job, school or playtime. That makes vacations and long weekends the most popular times for appointments.

"I tell them to put aside a few days and plan not to look their best," West said. "In other words, don't schedule any first dates. But then they'll be done, their teeth won't grow back and they'll never have to deal with it again."

By the time people hit their late 20s and especially after age 35, they are at higher risk for complications. Those include swelling, bleeding, infection, nerve damage and a painful condition called "dry socket," which happens when blood clots dislodge during healing and leave exposed bone within the tooth socket.

Anna Kavaya decided not to take her chances. At 17 and in braces, Kavaya had four wisdom teeth -- two that had grown in and two that poked partially through her gums. Three months ago, her orthodontist told her to get them all pulled so they wouldn't crowd the other teeth in her mouth.

But Kavaya, a rising senior at Tabb High School in York County, knew there was no way she'd do it until the summer. She scheduled surgery for July 7.

"I didn't want to go to school with a puffy mouth," she said. "My sister did the same thing. I'm sure a lot of people do. I just wanted to get it over with."

Still, the practice of taking out healthy teeth remains a source of debate for some doctors, who worry about the expense and, more importantly, potentially dangerous side effects of what could be unnecessary surgery. Insurance companies won't always pay for preventive operations, either.

To answer doubters, oral surgeons say complications are rare and point to new studies that show most people will suffer because of their wisdom teeth at some point in their lives. Decay and abnormal growth can cause everything from minor pain to life threatening infections and jaw tumors.

Trouble can start early, according to a recent clinical trial led by a North Carolina doctor who looked at 300 healthy people between 14 and 45. All started with four symptom-free teeth but over 21/2 years, about 25 percent developed early-stage gum disease around at least one tooth, Mrazik said.

"The numbers are significant," he said. "It's just too hard for people to clean them, because they're so far back in the mouth." Early gum disease can progress from redness and swelling to serious infections, tooth loss and a higher risk of heart conditions and stroke.

In another study, one in three adults who had wisdom teeth that didn't break all the way through the gums went on to develop fluid-filled growths called cysts in tissue around their teeth. While some cysts are harmless, others can do permanent damage to the jawbone and nerves or, much less commonly, trigger tumor growth.